Provider Demographics
NPI:1922654318
Name:KOURAFAS, BROOKE
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:KOURAFAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 AUDREYS LN
Mailing Address - Street 2:
Mailing Address - City:MARSTONS MILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02648-1631
Mailing Address - Country:US
Mailing Address - Phone:339-237-1374
Mailing Address - Fax:
Practice Address - Street 1:160 AUDREYS LN
Practice Address - Street 2:
Practice Address - City:MARSTONS MILLS
Practice Address - State:MA
Practice Address - Zip Code:02648-1631
Practice Address - Country:US
Practice Address - Phone:339-237-1374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health